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NBME 24 Answers

nbme24/Block 3/Question#49 (34.3 difficulty score)
A 20-year-old woman with asthma comes to the ...
Ask the roommate not to smoke in the apartment🔍
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ehT pleodo is rilealegpo,chyn dan a 1010/ good o.yb

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +  
mynamejeff  The poodle is hypoallergenic, and a 10/10 good boy. +  



 +7  upvote downvote
submitted by yotsubato(802),
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olCd ira cuindse shmata t.aactks

igesreacnD csueor alod wont hlpe

gaTnki tssredio si oot cmuh rof onw

Mogniv cbka to teh orsmd si nto evailb

irA elrsaecn otnd wrok ohgeun

tDno tge rdi of het Godo yBeo

mSgonik dsoorni si gtdnsugiis

sherry  Stress can actually be a trigger for asthma. I think the problem here is that she has alwasys carried a heavy course, while the disease just started recently. +4  
medguru2295  Stress makes asthma worse. Therefore, keep doggo for stress relief! +  
qiss  Also her symptoms started 3 months ago and she moved in with a roommate who smokes indoors 3 months ago. +1  



 +2  upvote downvote
submitted by lilmonkey(19),

Always chose smoking if you see it. In any type of question. Don't even read :)




 +2  upvote downvote
submitted by dragon3(10),
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I tolasm cpedik nigaks teh mroeaomt ont to esmko in eth era,mtaptn tub tehn I ruigfed hsat't bonyde het opecs fo het ..t.droco earhotn pornes sdia kgtian issertdo louwd be oot mcuh ofr n,wo adn I osppsue satth' ucaeseb hte mahsat is llreoectnlwold- hwit hre eiarhnl ?nr htas(t' atwh I adh epi)dck

sherry  I would say the patient's asthma only got worse after her moving out. So its more allergen-related. Getting rid of the allergen is always better than upgrading medications. +2  
et-tu-bromocriptine  Rippp the "don't be a dick" strategy definitely failed me on this one. For some reason, I thought requesting the patient to ask someone else to change their smoking habits would be a tad too much. I can just picture UWorld smacking me with a "Although it is likely that the roommate's cessation of smoking could alleviate the patient's asthma exacerbations, this request would be out of the physician's scope....etc." +31  
peqmd  Depends who's dickier the doctor telling the patient she shouldn't live in smoke or some guy smoking in the house +  



So we are just supposed to know that poodles are hypoallergenic...

I put "get an air cleaner" because I thought asking the roommate to stop smoking would be beyond the scope of the physician and since I didnt know poodles were hypoallergenic, I thought "well, even if the roommate stopped smoking, she'll still have issues because of the pet dander."

cries

luciana  Same here, I got confused because it seemed that the smoke AND the dog were the triggers, so I picked "Move back to the dormitories" so all the triggers would be gone. Who would imagine poodles were hypoallergenic +  
luciana  For those like me who didn't know there was 1 hypoallergenic dog, there are 23 to you memorize :) https://blog.homesalive.ca/dogs-that-dont-shed-23-hypoallergenic-dog-breeds +  



 +1  upvote downvote
submitted by whoissaad(65),
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hatW ugaratnee od ew have taht eht aremtmoo si oggni to tspo oskingm ni eht mtaeaptnr yb sn"kgi"a him ot do .s.o?

krewfoo99  There is no guarentee. They are basically asking what a trigger is for her asthma recurrence. Smoking in this scenario can be the cause of this patients symptoms. Dont dwell to deep into the question. +1  



I honestly don't understand why A is the correct answer. I picked "move back to the dorm" because there are three asthma triggers in her dorm: (1) the smoker, (2) the fact that her roommate doesn't like it when it's too warm (she doesn't want to be cold, and cold is a trigger for asthma), and (3) the stress of people who don't clean their dishes. Stress, cold, and smoke. Those are triggers for asthma that are present in her apartment. Is anyone else not seeing this?

123ojm  Because presumably she's already signed a lease and cannot afford to pay a second rent by moving back into the dorms. I think this goes back to making suggestions for our patients that are reasonable for them to achieve. +  
123ojm  Also her roommate is the one that makes it warm, so the apartment is not cold +